title: Air transported pediatric rescue extracorporeal membrane oxygenation: a single institutional review.
abstract: BACKGROUND
  Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO.
  
  
  METHODS
  A retrospective review was conducted of all patients initiated on rescue-ECMO from 2004 to 2009 in a single academic pediatric hospital without a pediatric cardiac surgery program. All aspects of ECMO were formalized using Failure Mode Effects Analysis.
  
  
  RESULTS
  Eight patients were initially cannulated for ECMO at our institution. Six were subsequently transported by air to the receiving facility 1,305 km away. Extracorporeal membrane oxygenation was initiated in 0.2% of our Pediatric Intensive Care Unit admissions and in 0.52% of all our pediatric cardiac patients. Mean age was 4.0 years (7 weeks to 15 years). Indications for ECMO initiations were cardiogenic shock (n = 5) and acute respiratory distress syndrome (n = 3). Six had veno-arterial- and two had veno-veno ECMO. Two patients were not transported (one death and one weaned locally). Six patients were successfully transported within 2 to 24 hours, with a survival to hospital discharge rate of 67% (four of six). Median total time on ECMO was 5.5 days. Complication rate was 50% (4/8).
  
  
  CONCLUSIONS
  Our rescue-ECMO survival results were comparable to that of current published results from established pediatric ECMO programs. Air transport of ECMO patients can be performed safely using an organized multidisciplinary team approach.
authors.affiliation: Department of Surgery, Cardiac Surgery, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Horne
authors.forename: John J
authors.initials: JJ
authors.lastname: Lee
authors.forename: Mike
authors.initials: M
authors.lastname: Maas
authors.forename: Abhay
authors.initials: A
authors.lastname: Divekar
authors.forename: Murray
authors.initials: M
authors.lastname: Kesselman
authors.forename: Tanya
authors.initials: T
authors.lastname: Drews
authors.forename: Stasa
authors.initials: S
authors.lastname: Veroukis
authors.forename: Betty J
authors.initials: BJ
authors.lastname: Hancock
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Gerarda
authors.initials: G
authors.lastname: Cronin
authors.forename: Reeni
authors.initials: R
authors.lastname: Soni
keywords: ECMO (extracorporeal membrane oxygenation); acute respiratory distress syndrome (ARDS); cardiology; circulatory assistance